The Socioeconomic Burden of Coronary Heart Disease in Korea / 예방의학회지

OBJECTIVES: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. METHODS: A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. RESULTS: Estimated national spending on CHD in 2005 was 2.52 billion dollar . The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was 3183 dollar, which is about 2 times higher than the cost for angina (1556 dollar). CONCLUSIONS: The total insurance-covered medical cost (1.13 billion dollar) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Socioeconomic Costs of Stroke in Korea: Estimated from the Korea National Health Insurance Claims Database / 예방의학회지

OBJECTIVES: To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. METHODS: We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients' and caregivers' productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. RESULTS: A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. CONCLUSIONS: Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.

Survival of a Neartotally Amputated Auricle by Simple Closure and Medical Leech

PURPOSE: In an amputated auricle, a microvascular anastomosis is the best treatment of choice. But, the neartotally amputated auricle which is connected by very narrow tissue pedicle to the head, can survive by simple attachment without a microvascular anastomosis owing to the rich vascular network through the superficial temporal artery and posterior auricular artery. In cases of venous congestion resulting from a lack of vein anastomosis, medical leeches (Hirudo medicinalis) can solve the problem. We are reporting the case of a 6-year-old boy who had a neartotally amputated auricle with successful results by simple closure and medical leech treatment without a microvascular anastomosis. METHODS: A 6-year-old male patient had an left auricular injury by an escalator accident. The left auricle was neartotally amputated from the temporal head with connection only by very narrow skin and subcutaneous pedicle(about 1cm in width) at the helical root of upper and anterior part of auricle. Marginal bleeding from the avulsed auricle was noted and the arterial blood was supplied from a branch of upper auricular branch of the superficial temporal artery. The auricle was repaired by simple closure including cartilage and skin without any vascular anastomosis. After simple closure, the auricle showed good circulation with pink color. But on the 2nd day after the operation, there was a venous congestion with severe swelling, which resulted in a purplish colored auricle. The venous congestion disappeared after using medical leeches by the 5th day after the operation. RESULTS: The repaired auricle showed aesthetically and functionally satisfactory result with normal development at the 9 months follow-up check after the operation. CONCLUSION: In cases of neartotally amputated auricles of children or crushing injury in which microsurgery is difficult, we can try simple closure with the use of medical leeches in treating a of venous congestion for a successful result.

Survival of a Neartotally Amputated Auricle by Simple Closure and Medical Leech

PURPOSE: In an amputated auricle, a microvascular anastomosis is the best treatment of choice. But, the neartotally amputated auricle which is connected by very narrow tissue pedicle to the head, can survive by simple attachment without a microvascular anastomosis owing to the rich vascular network through the superficial temporal artery and posterior auricular artery. In cases of venous congestion resulting from a lack of vein anastomosis, medical leeches (Hirudo medicinalis) can solve the problem. We are reporting the case of a 6-year-old boy who had a neartotally amputated auricle with successful results by simple closure and medical leech treatment without a microvascular anastomosis. METHODS: A 6-year-old male patient had an left auricular injury by an escalator accident. The left auricle was neartotally amputated from the temporal head with connection only by very narrow skin and subcutaneous pedicle(about 1cm in width) at the helical root of upper and anterior part of auricle. Marginal bleeding from the avulsed auricle was noted and the arterial blood was supplied from a branch of upper auricular branch of the superficial temporal artery. The auricle was repaired by simple closure including cartilage and skin without any vascular anastomosis. After simple closure, the auricle showed good circulation with pink color. But on the 2nd day after the operation, there was a venous congestion with severe swelling, which resulted in a purplish colored auricle. The venous congestion disappeared after using medical leeches by the 5th day after the operation. RESULTS: The repaired auricle showed aesthetically and functionally satisfactory result with normal development at the 9 months follow-up check after the operation. CONCLUSION: In cases of neartotally amputated auricles of children or crushing injury in which microsurgery is difficult, we can try simple closure with the use of medical leeches in treating a of venous congestion for a successful result.

Socioeconomic Costs of Alcohol Drinking in Korea

BACKGROUND: The purpose of this study was to estimate socioeconomic costs caused by alcohol drinking in Korea as of 2004 in an effort to raise the awareness of the gravity of problems associated with alcohol drinking and the necessity of active intervention by family physicians. METHODS: The costs were classified as direct costs, indirect costs and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by the reduction and loss of productivity and the loss of workforce. Other costs consisted of property loss, administration costs and costs of alcohol beverage. RESULTS: The annual costs, which seemed to be attributable to alcohol drinking, were estimated to be 200,990 hundred million won (2.9% of GDP). In the case of the former, the amount included 38.83% for reduction of productivity, 26.92% for loss of the workforce, 22.24% for alcoholic beverage, 5.34% for direct medical costs, 2.29% for loss of productivity, 1.87% for direct non- medical costs, 1.54% for administration costs and 0.97% for loss of property. CONCLUSION: Our study confirms that compared with the cases of Japan (1.9% of GNP), Canada (1.09% of GDP), France (1.42% of GDP) and Scotland (1.19% of GDP), alcohol drinking incurs substantial socioeconomic costs to Koreans. An active intervention by family physicians is suggested.

The Effect of Heparin on Gene Expression of Collagen, MMP, TGF-beta Isoforms Using Cultured Fibroblast from Transverse Carpal Ligament of Carpal Tunnel Syndrome

PURPOSE: Noninflammatory synovial fibrosis has been noted for main causal factor of carpal tunnel syndrome (CTS). Recently, there are some reports that heparin have not only anti-coagulative effect but also anti-inflammatory and anti-fibrotic potential and have an effect on interstitial pulmonary fiborosis. Authors examined whether heparin affects pathogenesis of CTS. METHODS: First, heparin was administered to fibroblast that was cultured from patient's transverse carpal ligament. Secondly, we evaluated the expression from genes of type I, III collagen, TGF beta isoforms and MMP. Fibroblasts were isolated and cultured from transverse carpal ligaments of 5 patients with CTS. Heparin (0, 1, 10,100microgram/ml) was administered to cultured fibroblast and reverse transcription PCR for mRNA expression of type I, III collagen, TGF-beta isoforms and MMP was done. RESULTS: Heparin suppressed gene expression of type I, III collagen and TGF-beta1, beta3 but promoted gene expression of TGF-beta(2) and MMP-2. CONCLUSION: Heparin directly suppress gene expression of type I, III collagen. But, It is undetermined that heparin can present it's effect mediated by TGF beta iso forms or MMP.

Interest Groups' Influence over Drug Pricing Policy Reform in South Korea

In 1999, the Korean government made a drug pricing policy reform to improve the efficiency and transparency of the drug distribution system. Yet, its policy formation process was far from being rational. Facing harsh resistance from various interest groups, the government changed its details into something different from what was initially investigated and planned. So far, little evidence supports any improvement in Korea's drug distribution system. Instead, the new drug pricing policy has deteriorated Korea's national health insurance budget, indicating a heavier economic burden for the general public. From Korea's experience, we may draw some lessons for the future development of a better health care system. As a society becomes more pluralistic, the government should come out of authoritarianism and thoroughly prepare in advance for resistance to reform, by making greater efforts to persuade strong interest groups while informing the general public of potential benefits of the reform. Additionally, facing developing civic groups, the government should listen but not rely too much on them at the final stage of the policy formation. Many of the civic groups lack expertise to evaluate the details of policy and tend to act in a somewhat emotional way.

Seeking to Allow for-Profit Health Care Providers in Korea

No abstract available.

Case Report of Malignant Eccrine Poroma on Lower Abdomen

Malignant eccrine poroma is a rare malignant tumor that arises from the intraepithelial ductal portion of the eccrine sweat gland. It may be developed either spontaneously or from a preexisting benign eccrine poroma. We report a case of malignant eccrine poroma on right lower abdomen in a 78-years-old female, which has been present for 1 year. In our case the tumor demonstrated without local invasion and distant metastasis, and was successfully removed by surgery.

Comments on the Policy of Separation Between Prescribing and Dispensing Medicines

No abstract available.

Time Series Observations of Outcome Variables and the Factors Associated with the Improvement in the Patient Outcomes of Cataract Surgery / 예방의학회지

OBJECTIVES: To compare the multiple outcomes of patients with cataract surgery at perioperative time, 3-4 months and 12 months after surgery and to assess patient outcomes associated with visual improvement(visual acuity of operated eye, visual function-14(VF-14), symptom score). METHODS: For this assessment, a prospective study was conducted with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was performed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data were obtained. Doctors were questioned with self-reported questionnaire forms. Medical records were examined in order to measure variables related to the surgical process such as surgical methods and ocular comorbidity. The survey was conducted at 4 stages : preoperative time(389 cases), perioperative time(344 cases, 88.4%), postoperative 3-4 months (343 cases, 88.2%), and postoperative 12 months (281 cases, 72.2%). After excluding cases with incomplete data, 198 cases were enrolled in the study. Patient outcomes was measured for any improvement in the functional outcomes(visual acuity of operated eye, visual function, symptom score) at postoperative 3-4 months. RESULTS: The visual acuity(operated, weighted average), symptom score, VF-14 score, satisfaction with vision, and subjective health status were shown to be improved at the perioperative time, postoperative 3-4 months and 12 months. An improvement in the Snellen visual acuity score was observed in 190 patients(96.0%), whereas improvements of the VF-14 score and cataract symptom score were observed in 151 patients(76.3%) and 179 patients(90.4%), respectively. All three outcome measures demonstrated improvement in 137 patients(69.2%). The improvement of the three functional outcomes at 3-4 months after receiving surgery was associated with a lower level of visual function and a higher level of cataract symptom score at perioperative time, as well as a greater experience level of the surgeon. CONCLUSIONS: In this study, the estimates of the proportion of patients benefiting from cataract surgery varied with the outcome measure of benefit. Preoperative VF-14 score, a measure of functional impairment related to vision, and symptom score may be better measures of the benefit derived from cataract surgery than the change in visual acuity.

Variation in Cataract Surgery Practice and Clinical Outcomes

PURPOSE: The purpose of this study was to examine the variations of the clinical outcomes of cataract surgery according to the characteristics of patients and surgeons and surgical technique. METHODS: The survey was conducted at 4 stages : preoperative period(389), perioperative period(344, 88.4%), postoperative 3~4 months(343, 88.2%), and postoperative 12 months(281, 72.2%). RESULTS: Eighty-five percent of surgery was performed by phacoemulsification and 14% by standard extracapsular (ECCE) techniques. The performance of phacoemulsification was associated with years of practice(11 years or more) and annual volume of cataract surgery(201 cases or more). The reported occurrence of posterior capsular opacification within 12 months of surgery was decreased in the patients operated by surgeons with years of practice(11 years or more). CONCLUSIONS: The factors influencing to better outcomes at 12 months after surgery were visual acuity of baseline operated eye(20/200 or less) and the absence of ocular morbidity. In this study, although there were some variations with cataract surgery practice, but the variations with cataract surgery practice did 434not give much influence to the patient's outcomes.

Predictors of Successful Control for Selfishness, Dishonesty, Resentment, and Fear (SDRF) among Korean Alcoholics Anonymous Members / 예방의학회지

OBJECTIVES: To examine predictors of successful control for selfishness, dishonesty, resentment, and fear(SDRF) among Korean Alcoholics Anonymous(AA) members. METHODS: This study was a cross-sectional study. The study group included members from 18 different AA groups which were enrolled in the Korean AA Association in 1998. 207 out of 300 self administered questionnaires were completed by AA members (response rate 69.0%). Alcoholics who attended AA meetings were divided into two groups according to their self reported level of success in SDRF control; one with very successful experience after AA participation and the other with little or no success. In this study, the general characteristics, AA activities, relapse experience, and degree of effort exerted for SDRF control were compared between two groups. In order to study predictors of successful SDRF control after joining AA, 4 logistic regression analyses were performed for each of the 4 SDRF indices. RESULTS: The proportion of those reporting a very successful experience was 19.9% for selfishness, 20.7% for dishonesty, 25.5% for resentment, and 24.7% for fear. After control for the effect of general characteristics, the practice of the 12th step(taking alcoholics to an AA meeting after conveying messages) was found to be a significant predictor for the successful control of both selfishness(OR=6.04) and the dishonesty(OR=7.77). And individuals making every effort for SDRF control showed more successful control of selfishness(OR=4.10), dishonesty(OR=4.01), and fear(OR=34.89). CONCLUSIONS: Bivariate and multivariate analyses demonstrated that especially practicing the 12th step and making every effort themselves, may help alcoholics to control SDRF successfully after joining AA.

Analysis of Socioeconomic Costs of Smoking in Korea / 예방의학회지

OBJECTIVE: To estimate the annual economic costs attributable to cigarette smoking in Korea. METHODS: The costs were classified as being direct medical and non-medical costs, indirect costs and others. We focused on those costs related that are incurred in the treatment of selected diseases (cardiovascular diseases, respiratory diseases, and cancers), which have been proven to be caused by smoking. In addition to the basic costs of treatment, the additional amount of costs occurred due to smoking was obtained by computing the population attributable risk (PAR%) caused by smoking. To compute the PAR%, relative risks of smoking to the number of outpatient visits, hospitalizations, and the death were estimated using the Cox proportional hazard model, respectively. Our major data source was the 'Korea Medical Insurance Corporation (KMIC) cohort study,' which was composed of a total of 115,682 male and 67,932 female beneficiaries who had complete records of their smoking histories in the year of 1992. RESULTS: The annual costs that could be attributable to smoking were estimated to be in the range of 2,847,500 million Won to 3,959,100 million Won. The maximum estimate of 3,959,100 million Won includes 233,100 million Won for medical costs, 5,100 million Won for transportation costs, 27,600 million Won for care giver's economic costs, 69,100 million Won in productivity loss, 3,435,000 million Won lost because of premature death, 172,100 million Won in costs resulting from passive smoke inhalation and 17,100 million Won for costs that resulted from fires that were caused by careless smoking. CONCLUSION: Our study confirms that the magnitude of the economic burden of smoking to Korean society is substantial. Therefore, this study provides strong evidence that there is a strong need for a national policy of tobacco control in Korea.

A Comparison of Clinical Results in Unilateral and Bilateral Cataract Surgerys

PURPOSE: This study compares the outcomes of unilateral cataract surgery to those of bilateral cataract surgery in patients with cataract of both eyes. METHODS: Among a total of 153 patients, 61 underwent unilateral surgery and 92 bilateral surgery. RESULTS: The unilateral and bilateral surgeries were similar in demographic and ocular characteristics including visual acuity and visual function-14, except patient-reported factor, such as trouble with vision at baseline. The patient-reported factor was more serious in bilateral surgery than in unilateral surgery. The changes of three outcomes were associated not with unilateral eye or bilateral eye surgery, but with each baseline condition. CONCLUSION: The patient-reported factors such as symptom score, trouble with vision were the significant outcomes to decide unilateral or bilateral surgery in patients with cataract of both eyes. The result of unilateral or bilateral surgery did not affect the outcomes of cataract surgery after 12 months.

Factors Affecting the Participation Rate in the Health Screening Program of Medical Insurance / 예방의학회지

OBJECTIVE: To analyze the factors affecting the participation rate in the health screening program of medical insurance. METHOD: We investigated the factors associated with the participation rate in the health screening program in Korea. Data were collected at the aggregate level from 145 employee health insurance societies and 227 self-employed health insurance societies from 1995 to 1997. Data were also collected at the individual level from four health insurance societies. This study hypothesized that the participation rate of the health screening program was related to 1) the characteristics of its members and the size of the health insurance society; 2) the specifications of the health screening program; 3) the venue of the health screening institution and the interests of individuals in the health screening program; and 4) the activities of the health insurance society. We used bivariate and multiple regression models to examine the factors on the participation rate of the health screening program. RESULTS: First, in the case of dependents of on employee health insurance society, the ratio of dependents 40 years old and over, the average monthly contribution per household, the interest and satisfaction level of individuals in health screening, and the level of refunds for over-payment were all associated with the participation rate in the health screening program, accounting for 54.4% of the participation rate. Second, in case of those insured by the self-employed health insurance society, the interest and satisfaction level of individuals in health screening, the level of refunds for over-payment, and the performance level of on-the-spot health screening were statistically significant, accounting for 40.1% of the participation rate. CONCLUSION: The factors concerning the participation rate in the health screening program of medical insurance, in both a health insurance society and for individuals, were closely related to the age and gender of individuals and household contributions.

Cost-benefit Analysis of Mandatory Prescription in Korea / 예방의학회지

OBJECTIVE: To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription Syste m' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). METHODS: The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. Indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was performed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. RESULTS: The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. CONCLUSION: The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.

Comparative Analysis of Subcutaneous Thickness of Each Compartment of Abdomen & the Selection of Cannula Insertion Site in Liposuction

The thickness of the abdominal subcutaneous tissues is discussed in the data obtained in 40 middle-aged female patients(the range of the age 31 to 60 years) examined on a modern computed tomographic system. The authors have shown that the superficial fascia, which separates the superficial and deep layers of subcutaneous fat, forms a continuous circumferential fascial plane. We have analyzed cross-sectional CT images at the umbilical level in a middle ged women. The authors have made several linear measurements of the thickness of the superficial and deep fat compartments at various reference points around the trunk in order to demonstrate the regional distribution of the deep fat compartment. Our data shows the mean, standard deviation(SD) concerning the thickness measurements of the superficial and deep fat compartments around the abdomen in the 40 women. From these observations, we concluded that the thickness of subcutaneous tissue of superficial layer is relatively constant and the thickness of subcutaneous tissue of deep layer is greatest at posterolateral region with decrements in thickness at anterior, lateral region respectively. And such pattern is same as the total subcutaneous tissue thickness, therefore, relatively safe parts for much amount of liposuction around the abdomen are paralumbar region and anterior abdomen. Such study result could offer the appropriate depths for cannula insertion, that is, 18.8mm at anterior, 16.9mm at lateral and 32.5mm at posterolateral region. Such knowledge could offer a guide to the necessary depth of cannula insertion when performing of the SAL (suction-assisted lipectomy). It is deemed desirable to place the tip in the middle of the deep compartment.

Enrichment of Health Insurance Financing and Rational Adjustment of Fee Schedule

No abstract available.

The Experimantal Studey of Delayed Wound Healing on Full-Thickness Skin Defects in Diabetic Rats

Wound healing was a natural process proceeded by connective tissue deposition, epithelialization, and wound contracture. Streptozotocin-induced diabetes mellitus was known to impair wound healing. However, the extend of delayed wound healing was not evaluate objectively in the diabetic rats. Therefore, we studied the extend of delayed wound healing(epithelialization and wound contracture) and histologic difference between diabetic and control rats. Twenty adult Sprague-Dawley rats(200-250 gm) were used as experimental animals(Diabetes: 10 rats, control: 10 rats). The wounds(2 x 2 cm, sized) were made on the back of the rats by excision through the panniculus carnosus. The areas of both wounds in relation to original wound areas (operative day) were serially measured at 0, 1,2, 3, 4, 5 weeks postoperatively. In addition, we performed histological examination of biopsy taken at 0, 1,2, 3, 4, 5weeks postoperatively. The difference in the mean area ratio between two groups was then compared using Kruskal Wallis test(SAS Program). Results were as follows: At postoperative 1 week, there was a significant difference(p < 0.05) in degree of epithelialization between the two groups, 1) After postoperative 2 weeks, there was a significant difference(p<0.05) in degree of wound contracture between the two groups. 2) In the diabetic group, the collagen fibers were smaller and poor organized than control group. Conclusion was that delay of epithelialization early and delay of wound contracture late in wound healing, were important roles in diabetic wound problem.